Decreased urine output is associated with increased in-hospital mortality from sepsis-associated acute respiratory distress syndrome
1Department of Geriatrics and Special Service Medicine, First Affiliated Hospital of Army Medical University (Southwest Hospital), 400038 Chongqing, China
2Department of Critical Care Medicine, the Second Affiliated Hospital of Chongqing Medical University, 400010 Chongqing, China
3Department of Cardiology, the Second Affiliated Hospital, Chongqing Medical University, 400010 Chongqing, China
4Precision Medicine Center, the Second Affiliated Hospital of Chongqing Medical University, 400010 Chongqing, China
DOI: 10.22514/sv.2023.028 Vol.19,Issue 3,May 2023 pp.112-120
Submitted: 31 August 2022 Accepted: 18 October 2022
Published: 08 May 2023
† These authors contributed equally.
The relationship between urine output (UO) and in-hospital mortality in patients with sepsis-associated acute respiratory distress syndrome (ARDS) has not been elucidated. The demographic and clinical characteristics of patients from the intensive care unit with sepsis-associated ARDS in the Medical Information Mart for Intensive Care-IV database were collected, and binomial logistic regression was performed to determine whether UO was an independent risk factor for in-hospital death. Using the Logistic Organ Dysfunction System (LODS) and Sequential Organ Failure Assessment (SOFA) as a reference, receiver operating characteristic (ROC) curves were drawn to analyze the efficacy of UO in predicting in-hospital mortality, and the Kaplan-Meier curve was drawn with the optimal cut-off value of the ROC curve. Decision curve analysis (DCA) was performed to assess the clinical net benefit of UO in predicting in-hospital mortality. UO was an independent risk factor for in-hospital mortality in patients with sepsis-associated ARDS. The area under the ROC (AUC) for UO in predicting in-hospital mortality was 0.712, which was comparable to LODS and SOFA. The patients were grouped by the optimal UO cut-off value (1515 mL/day) identified by the ROC curve. The results showed that the median in-hospital survival time for the low-UO group was 20.565 days, and that of the high-UO group was 84.670 days. The risk of in-hospital death of the low-UO group was 3.0792 times that of the high-UO group. DCA showed that when using UO to predict in-hospital mortality, the clinical net benefit was higher than LODS or SOFA at almost all available threshold probabilities, particularly when the threshold probability was between 0.2 and 0.4. As a result, UO showed moderate efficacy in predicting in-hospital mortality, and when used to predict the in-hospital mortality of patients with sepsis-related ARDS, its clinical net benefit was higher than that of LODS or SOFA.
Urine output; Sepsis; Acute respiratory distress syndrome; In-hospital mortality; MIMIC-IV
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